USMLE Step 1 “Score Creep” Adversely Affects Dual-Degree Students

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Over the past decade, the United States Medical Licensing Examination (USMLE) has experienced a steady but significant increase in average scores, particularly on Step 1, which is traditionally administered at the end of a medical student’s second year. As evidenced by the National Resident Matching Program’s 2016 publication “Charting Outcomes in the Match,”1 and by historical Match data,2 this trend of gradual but steady increases in board scores over time, or “score creep,” does not appear to be slackening.
For most medical students, the method of score reporting used by the USMLE is not a cause for concern; students compete for residency slots against colleagues who took their Step 1 examinations at more or less the same point in time. But for students enrolled in joint-degree programs—as well as those who take time between their second and third years of training to pursue research or other experiences—the perceived value of their Step 1 scores may be diminished when they go on to compete for residency positions against students who have taken Step 1 more recently. MD–PhD students are particularly likely to see the value of their Step 1 scores “depreciate,” as many require up to four or five years after taking Step 1 to earn their PhD before returning to the clinic.
Multiple studies have determined that residency programs rank Step 1 scores among the top factors considered for selecting applicants to interview.3,4 However, questions remain as to whether residency programs consider the year in which students took their examinations, as well as whether the phenomenon of “score creep” has a detrimental effect on students who take time between their preclinical and clerkship years to pursue research, service, or an additional degree.
So, what is the solution? Barring a move from the current National Board of Medical Examiners approach toward a more normalized scoring system, GME program directors should make a concerted effort to consider Step 1 scores in the context of the year in which they were taken. Otherwise, students may be discouraged from pursuing dual-degree programs or other research and service activities for fear of being penalized with a depreciating Step 1 score.
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